'Not everything that can be counted counts and not everything that counts can be counted'– towards a critical exploration of modes of satisfaction measurement in sheltered housing

This paper reflects on a research project funded by a consortium of leading sheltered housing (SH) providers and their regulatory body, the Housing Corporation. The project aimed to ascertain which aspects of SH older people perceived to be central to their satisfaction and the methods they judged most appropriate to measuring this. We outline key policy developments of importance to SH (specifically the development of performance measurement regimes), and changes in the nature of SH, which are driving providers to re‐evaluate how they measure user satisfaction. We discuss the aims of the project, our methodology and findings, and conclude by raising critical questions about the process of measuring satisfaction within an increasingly managerialised housing system. We argue that this favours standardised methods of information gathering (such as questionnaires) rather than engage with clients in order to develop methods and systems capable of eliciting qualitative issues of concern to them. Our conclusions are, we believe, applicable to health and social care provision, where similar tensions exist around performance measurement and user satisfaction.     

Production of interleukin-1 and tumor necrosis factor by bone marrow-derived macrophages: effect of cisplatin and lipopolysaccharide

Mature macrophages derived in vitro from bone marrow progenitors under the influence of either L929 CM (a source of M-CSF) or GM-CSF have been shown to differ morphologically and functionally. Treatment of these bone marrow-derived macrophages with cisplatin or LPS resulted in the expression of enhanced tumoricidal activity and the production of significant amounts of extracellular and membrane-associated IL-1 and TNF. rGM-CSF-derived bone marrow macrophages produced higher amounts of TNF and IL-1 activity than L929CM-derived macrophages. Untreated bone marrow-derived macrophages showed little IL-1 and TNF activity. Bone marrow macrophages cultured with medium alone also did not respond to cisplatin or LPS for the production of IL-1 and TNF. Neutralization studies with anti-IL-1 and anti-TNF antibodies inhibited the IL-1 and TNF activity of bone marrow-derived macrophages. These results suggest that cisplatin or LPS treatment of murine bone marrow-derived macrophages results in increased expression of both released and membrane-associated IL-1 and TNF.     

Effect of TNF priming of murine peritoneal macrophages on their activation to a tumoricidal state

Murine peritoneal macrophages, on treatment with TNF (10 U/ml) for various durations, showed enhanced cyototoxicity against tumor target cells. The macrophage-mediated cytotoxicity was significantly enhanced when TNF-primed macrophages were treated with cisplatin, LPS, FK-565 or interferon-gamma for 24 h, compared to unprimed and treated macrophages. TNF-primed macrophages also showed enhanced expression of interleukin-1 and tumor necrosis factor activities on activation with different biological response modifiers.     

Age-associated hematopoietic alterations in the spleen of tumor-bearing hosts

The present investigation was carried out to study the effect of tumor growth on the spleen of an aged host. Dalton's lymphoma (DL), a spontaneous T cell lymphoma, was grown in mice of different age groups classified as young, adult or old on the basis of their reproductive status. Splenocytes obtained from normal and tumor-bearing young, adult and old mice were checked for an in vitro blastogenic response to concanavalin A (Con A), colony-forming ability and apoptosis. There was an enhanced apoptosis of splenocytes and a concomitant inhibition of splenocyte blastogenesis and their responsiveness to the mitogenic stimulus of Con A in aged mice. The counts of granulocyte macrophage- and macrophage-colony forming units were significantly enhanced in the spleen of tumor-bearing adult mice. It is proposed that the DL-growth-dependent increase in the size of the spleen in adult mice is due to an increased blastogenesis of splenocytes, which, however, may not be applicable in the case of old tumor-bearing mice. The role of splenic macrophages in the regulation of the functions of the spleen by macrophage-derived NO is shown.     

Anaesthetic management of a patient with pemphigus vulgaris for emergency laparotomy

A 45-year-old man with a long-standing history of duodenal ulcer presented with symptoms and signs of perforation peritonitis. He also had lesions of pemphigus vulgaris throughout the body, involving both skin and mucous membranes. Care was taken to avoid pressure and friction during placement of monitoring devices, intravenous and arterial lines. Since the patient had to undergo exploratory laparotomy, intubation was performed in an atraumatic manner after rapid sequence induction. However, there was minor bleeding from the mucous lesions of the oral cavity, which was controlled by a saline adrenaline throat pack. The patient was extubated at the end of the surgery and steroids were continued in the peri-operative period.     

Pseudolipoma of the Inferior Vena Cava

Pseudolipoma of inferior vena cava refers to a normal variant of adipose collection that is seen in typical pericaval or juxtacaval location; however, it mimics an intracaval mass lesion, especially fat-containing lesions such as lipoma. Awareness of this entity is very important to avoid misdiagnosis and unnecessary diagnostic procedures.